Impact of Nodal Level Distribution on Survival in Oral Cavity Squamous Cell Carcinoma: A Population-Based Study

Otolaryngol Head Neck Surg. 2016 Jul;155(1):99-105. doi: 10.1177/0194599816636356. Epub 2016 Mar 15.

Abstract

Objective: Regional lymph node metastasis is an important prognostic factor in squamous cell carcinoma of the head and neck, decreasing survival by up to 50%. Oral cavity squamous cell carcinoma (OC-SCCa) most commonly spreads to levels I, II, and III.

Study design: Retrospective analysis of a population-based tumor registry.

Setting: Academic medical center.

Subjects and methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of OC-SCCa from 2004 to 2011 (22,973 cases). Resulting data including patient demographics, clinicopathological features, topographical distribution of nodal metastasis, and survival based on lymph node level involvement were analyzed.

Results: In total, 8281 patients were identified with OC-SCCa who underwent neck dissection. Level I, closely followed by levels II and III, represented the most commonly involved nodal basins. The 5-year disease-specific survival (DSS) for patients with only level I, II, or III was 42.0% compared with 30.6% for the level IV group (P < .0001) and 26.4% for the level V group (P < .0001). Surgery with adjuvant radiotherapy improved 5-year DSS for patients with level I to III, level IV, and level V neck disease compared with surgery alone (50.7% vs 48.6%, P = .0109; 39.9% vs 23.2%, P < .0001; and 33.3% vs 9.1%, P = .0005, for levels I-III, IV, and V, respectively).

Conclusion: Oral cavity squamous cell carcinoma most commonly involves nodal levels I, II, and III. Involvement of nodal level IV or V portends a worse prognosis than patients with only level I to III disease, and multimodality therapy should be considered for these patients.

Keywords: SEER database; epidemiology; neck cancer; neck dissection; regional metastasis; sex; squamous cell carcinoma; survival.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / therapy
  • Combined Modality Therapy
  • Female
  • Humans
  • Lymphatic Metastasis / pathology*
  • Male
  • Middle Aged
  • Mouth Neoplasms / pathology*
  • Mouth Neoplasms / therapy
  • Neck Dissection
  • Prognosis
  • Registries
  • Retrospective Studies
  • SEER Program
  • Survival Analysis
  • Treatment Outcome